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Low-Dose Oral Methotrexate in Chronic Progressive Multiple Sclerosis:Analyses of Serial MRIs Neurol 47:1153-1157, Goodkin,D.E.,et al, 1996 See this aricle in Pubmed Article Abstract We monitored 56 patients with chronic progressive multiple sclerosis(MS) who participated in a clinical trial of weekly,low-dose oral methotrexate with annual gadolinium-enhanced MRIs of the brain(Gd+MRI).None of these patients had clinical exacerbations during the 8 months preceding study entry.We also monitored 35 of these patients with serial Gd+MRIs every 6 weeks for 6 months.We observed a treatment effect,measured by absolute change in T2-weighted total lesion area(T2W-TLA),in the cohort that completed 6-week scans.We found change in T2W-TLA in this cohort to be significantly related to sustained change in performance on the nine-hold peg test but not to sustained change on the Expanded Disability Status Scale.Gadolinium enhancement of lesions on 6-week and annual scans was uncommon.Prestudy exacerbation frequency appears to be an important consideration in designing future clinical trials in patients with secondary and primary progressive MS.

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